Which are common first-line anticonvulsants used in acute seizures?

• A. Levetiracetam followed by Lorazepam
• B. Valproic acid alone
• C. Lorazepam (or Diazepam) followed by IV Phenytoin or Levetiracetam
• D. Lamotrigine monotherapy

Answer: (C)

In acute seizures, stopping the seizure quickly is the priority, then preventing recurrence. The fastest way to achieve that is with a benzodiazepine because it acts quickly on the GABA system to suppress seizure activity. When IV access is available, lorazepam is preferred because it has a longer duration of action, which helps prevent early re-emergence of seizures. If seizures continue after the initial benzodiazepine, the next step is to give an IV antiseizure medication that can be given promptly and provide sustained control. Phenytoin (or its prodrug fosphenytoin) and levetiracetam are the common choices for this second line; either helps maintain seizure control and buys time for further management.

Therefore, giving a benzodiazepine first, followed by an IV antiseizure such as phenytoin or levetiracetam, reflects standard acute-seizure treatment. Other options without this two-step approach don’t address the need for immediate termination first or use a slower-acting agent that isn’t ideal for acute control.